This is the Blog of Will Weider. This is the place where I share what I have learned through my mistakes and other crazy things in the life of a healthcare CIO.

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EHR vs. EMR

I am always frustrated how some often used terms in Healthcare IT are used in very different ways by different people. A simple example is Electronic Health Record (EHR) and Electronic Medical Record (EMR).

For a period of time the term Computer-based Patient Record was hot, but that seems to have been a short-lived fad.

So, what is the difference between and EHR and an EMR? As we are in the midst of developing a new EHR strategy for our 400-physician group this is a debate that is near and dear to my heart.

I think CCHIT and HL7 EHR-S do a nice job of describing core EHR capabilities. Those would include medication management, allergy list, problem lists, immunization, etc.

However, we are looking for a phrase that captures what we are trying to do. For our purposes we are saying that the EHR promotes the practice of medicine. Whereas an EMR is simply an electronic version of the traditional medical record. That is, the information is in there and it is retrievable, but it is generally organized around the hospital departments.

We have great doctors at Affinity and Ministry. Our goal is to continue to provide better tools that allow physicians to focus on the practice medicine, not search for data. By giving them IT systems that present the most clinically relevant information to care for each patient we can make these doctors even more efficient and effective.

A few years back I used to define an EMR as the electronic replacement for the paper based chart/medical record. I defined an EHR as that collection of EMRs existing at various providers. For example, a person’s EHR would be their EMRs from their physician, any refered physicians, and the EMRs from any hospital encounters.

These days, I consider an EMR to be the electronic replacement for the physician office paper record. An EHR to be the hospitals replacement of a paper record, usually with bells and whistles like CPOE, EMAR, and all those other acronyms thrown in. And a RHIO is supposed to glue all that stuff together. Unless its called a HIE, instead of a RHIO.

My question is when did the N in NHIN become “nationwide” instead of “national”? And was it because of fears of identification with “nationalized” medicine?

RE: Nationwide versus National – there is a more political issue around the movement from NHII (National Health Information Infrastructure) to NHIN (Nationwide Health Information Netwok). When the ONCHIT was formed and Brailer took the role, there was a general schism between the one largely considered to be the original promoter of the NHII (Bill Yasnoff) and the (now relabeled) ONC. I think Bill was miffed that he was left out of the whole thing and was further disenfranchised when NHIN started replacing NHII) in the ONC’s rebranding efforts.

My observations of Yasnoff’s behavior since reinforces that this may have been a good thing as he hasn’t shown himself to be someone who plays nice in the sandbox with others. Sorry to be anonymous on the note, but it’s a sensitive issue and would rather this comment come from a “source whose name has been withheld”.

We discuss the frequency of these terms (and others) showing up in Google searches. Surprisingly, while EHR had been catching up quickly to EMR, it has not yet surpassed it, as of November 2007, with 867K for Electronic Medical Record and 736K for Electronic Health Record. However, EHR is more prevalent than is EHR now with 5930K for EHR vs 5490K for EMR.